Internal Medicine Solution 2

Option D

Acute renal failure and diffuse intravascular coagulation are late complications of rhabdomyolysis (i.e., past 12 to 24 hours). Acute renal failure, the more serious complication, develops in up to 15 percent of patients and is associated with high morbidity and mortality.

Renal damage results from the mechanical obstruction of tubules by myoglobin precipitation, the direct toxic effect of free chelatable iron on tubules, and hypovolemia.

In addition, the release of vasoactive kinins from muscle may interfere with renal hemodynamics. There is a loose predictive correlation between CK levels and the development of acute renal failure, with levels higher than 16,000 units per L more likely to be associated with renal failure.

The rate at which serum creatinine levels increase is typically faster in patients with myoglobinuric renal failure (up to 2.5 mg per dL per day [220 µmol per L]) than in those with other causes of acute renal failure.

Category: Medicine MCQs